Sunday, April 3, 2011

Improving Health By Telling, and Hearing, Stories

The January issue of the Annals of Internal Medicine has a fascinating and important report of a randomized controlled trial of storytelling as an intervention with low income African Americans with high blood pressure. The study unites the best elements of town and gown medical cultures by combining an innovative caretaking intervention with a vulnerable inner city population (town) with rigorous academic research (gown).

Hypertensive patients at Cooper Green Mercy Hospital clinics, an inner-city, safety-net health system in Birmingham, Alabama, were randomized to (a) receiving a DVD with stories about hypertension and its treatment drawn from patients like themselves or (b) receiving a DVD about health habits. Both groups received usual care for hypertension.

The DVD interviews (examples of which can be seen via the link above) involve people from the patients' own community talking about what high blood pressure means to them, what motivates them to want to deal with the problem, and how to relate to the doctor. The findings were impressive. After 3 months, with further follow up at 7-8 months, patients who received the storytelling DVDs had a significantly greater reduction in blood pressure than the control group.

The study did not allow deep probing of how patients reacted to the DVD stories and what the mechanism of the observed effect might be. But the findings correlate with multiple other studies suggesting that peer influence can have a major impact on health behavior and health outcomes.

From the perspective of ethics, what stands out about this study is the way it combined the clinicians' passion to combat health disparities with the rigor of academic study. Typically these strands of medical life track separately. When this happens, promising clinical results which may be reported at conferences or written up from clinical observation don't compel belief because they're merely "anecdotal." And when academic research is done in the laboratory of a medical school clinic, the results may be methodologically rigorous, but they lack relevance because they don't come from real world situations.

The researchers, and the Robert Wood Johnson Foundation Finding Answers: Disparities Research for Change program, which funded the study, deserve congratulations for overcoming the forces that all-too-often keep committed community clinicians and academic researchers in separate silos.